Overview

Diaphragmatic hernia is a congenital anomaly that occurs due to failure of the diaphragm to close leading to herniation of the abdominal content into the thoracic cavity leading to pulmonary hypoplasia. It most commonly presents in the neonates as respiratory distress. It is classified according to the site of herniation into anterior, posterolateral, and hiatal diaphragmatic hernia. It can cause complications in both the GIT and the cardiopulmonary circulation. It can be diagnosed antenatally in the week 24 and after birth, it is apparent on chest x-ray. The mainstay of treatment is surgical correction which must be done when the infant is completely stabilized.

Historical Perspective

In 1679, the first case of congenital diaphragmatic hernia was reported by Riverius.[1]

In 1888, the first procedure to repair congenital diaphragmatic hernia in an adult was done and in 1889, the first procedure on an infant was done.

In 1905, the first successful operation was done but the success rate remained below 60% until 1925.[2]

In 1940, A set of diagnostic criteria for diaphragmatic hernia were suggested.

In 1950, the transthoracic approach was suggested instead of the transabdominal approach.

Classification

Congenital diaphragmatic hernia can be classified into three types according to the site of herniation.[3][4]

Posterolateral (Bochdalek) diaphragmatic hernia

It is the most common subtype.

Most commonly occurs on the left side and rarely occurs bilaterally.

Anterior (Morgagni) diaphragmatic hernia

In anterior diaphragmatic hernia, the intestine bulges into the thorax through the anterior midline.

Most of the cases of anterior diaphragmatic hernia occur on the right side.